Role of indocyanine green fluorescence imaging in margin assessment and recurrence-free survival in laparoscopic parenchyma-sparing hepatectomy for neuroendocrine tumor liver metastases

Gaoming Wang; Chenghao Liu; Weijun Qi; Long Li; Dianrong Xiu

doi:10.1007/s00464-024-11508-0

Role of indocyanine green fluorescence imaging in margin assessment and recurrence-free survival in laparoscopic parenchyma-sparing hepatectomy for neuroendocrine tumor liver metastases

Surg Endosc. 2025 Jan 6. doi: 10.1007/s00464-024-11508-0. Online ahead of print.

Authors

Gaoming Wang¹, Chenghao Liu¹, Weijun Qi¹, Long Li¹, Dianrong Xiu²

Affiliations

¹ Department of General Surgery, Peking University Third Hospital, Beijing, 100191, China.
² Department of General Surgery, Peking University Third Hospital, Beijing, 100191, China. xiudianrong64@126.com.

PMID: 39762608
DOI: 10.1007/s00464-024-11508-0

Abstract

Background: Neuroendocrine liver metastases (NELM) significantly reduce survival in patients with neuroendocrine tumor. The management of NELM is challenged by a low rate of resectability and a high rate of recurrence. Indocyanine green (ICG) fluorescence imaging offers potential advantages in real-time tumor visualization and margin assessment. This study evaluates the impact of ICG fluorescence on perioperative outcomes and recurrence-free survival (RFS) in NELM patients undergoing laparoscopic parenchyma-sparing hepatectomy (LPSH).

Methods: A retrospective cohort study was performed on patients with NELM who underwent LPSH from August 2013 to May 2023 at our single center. Data on sociodemographic characteristics, laboratory parameters, surgical results and follow-up outcomes were collected.

Results: A total of 51 NELM patients were included. No significant differences in baseline characteristics were observed between the ICG and non-ICG groups. Postoperative complications occurred in 52.9% of patients, with bile leakage being most common. No perioperative mortality was reported. Pathologically positive margins were significantly lower in the ICG group (1.3 vs. 16.4%, p < 0.001). After a median follow-up of 36 months, 62.7% of patients experienced recurrence, mostly intrahepatic. Median recurrence-free survival (RFS) was longer in the ICG group, though not statistically significant (38.0 vs. 29.0 months, p = 0.086).

Conclusion: The use of ICG fluorescence imaging in LPSH may improve surgical margins and potentially enhance RFS in NELM patients. These findings are clinically significant, highlighting the need for larger prospective studies to confirm its impact on long-term prognosis.

Keywords: Indocyanine green fluorescence imaging; Intrahepatic recurrence; Laparoscopic parenchyma-sparing hepatectomy; Neuroendocrine tumor liver metastases; Recurrence-free survival; Surgical margins.